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Maine rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,570.88 / $5,128.61 / $15,848.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,232.93 / $12,302.69 / $14,125.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $10,471.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,606.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $9,120.11 / $10,964.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $6,456.54 / $15,848.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $6,025.60 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $7,079.46 / $9,772.37